The role of pectoralis major muscle flap in salvage total laryngectomy

Objective: To assess the utility of the pectoralis major muscle flap (PMMF) in patients undergoing salvage total laryngectomy. Design: Retrospective cohort analysis. Setting: Tertiary care cancer center. Patients: The study included 461 patients who underwent laryngectomy. Eighty of them underwent salvage surgery with primary pharyngeal closure. Interventions: Of the 80 patients, 69 (86%) underwent primary pharyngeal closure alone and 11 (14%) underwent a PMMF, which was used to buttress the pharyngeal suture line. Main Outcome Measure: Two hundred thirty-six variables were recorded for each patient. Complications related to pharyngeal closure were measured. Results: Sixty-four percent of the patients who underwent PMMF also underwent chemoradiation therapy as the initial definitive treatment compared with 25% in the non-PMMF group (P=.03). On multivariate analysis, chemoradiation therapy was the only independent predictor of pharyngocutaneous fistula formation (relative risk, 1.82; P=.02). Nevertheless, the pharyngocutaneous fistula rate was similar in the PMMF (27%) and the non-PMMF (24%) groups. Furthermore, similar durations of tube feeding, days to oral feeding, and hospitalization period were recorded in both groups. Conclusion: The PMMF should be used judiciously as a surgical adjunct in high-risk patients, with the goal of minimizing the risk for the development of a pharyngocutaneous fistula.